Toronto EMS paramedics complain of staff and vehicles shortages

It was Saturday night, and the city was abuzz with an influx of downtown partygoers and an endless stream of 911 calls.

After completing a 12-hour shift, a Toronto paramedic with more than a decade of service was en route back to the station when he and his partner received an unusual instruction.

“The dispatcher came back to us, and she asked us to expedite our return to the station, because they had calls with no vehicles to send,” said the paramedic, who told his story to the National Post this week on condition of anonymity. “She told us subsequently… that we were to proceed with lights and sirens.”

The paramedics ultimately refused the order, understanding it to be a violation of the Highway Traffic Act, which waives speed limits only when ambulances are responding directly to emergency calls. Toronto EMS this week confirmed it was “looking into” last Saturday’s incident, which highlights a long-standing complaint among paramedics on staffing and vehicle shortages.

More paramedics have started to speak out in recent days about problems within Toronto’s ambulance service — but for different reasons, depending on who you ask. Paramedics say their work environment has degenerated to the point that public safety is at risk, while Chief Paul Raftis blames the rumblings on a subset of union stewards who are unhappy with newly negotiated changes to shift scheduling in paramedics’ collective agreement.

“The leaders of this faction(s) are running in an election in January for union positions that are part of the broader Local 416 executive,” Chief Raftis stated in a recent letter to city council. “They are part of a group who were not happy with the outcome of collective bargaining.”

The hard numbers alone tell a story. As the city’s population has grown and aged over the past decade, the number of emergency transports has risen by 35% while the number of paramedics has grown by just 1%, “resulting in reduced ambulance availability to respond to emergency calls,” the department’s 2013 budget documents acknowledge. Fifteen years ago, Toronto EMS arrived at life-threatening calls in eight minutes and 59 seconds, 84% of the time; last year, the $175-million service — which employs about 850 paramedics — was hitting that target just 63% of the time.

Things have never been worse

This fall, dozens of paramedics refused to work overtime shifts to protest what they have labelled a dire staffing shortage, alleging the service has been essentially “running on overtime,” with paramedics regularly staying hours past their scheduled 12-hour shifts.

“Things have never been worse,” said Brenda Brydges, an advanced-care paramedic with close to three decades of service. “I love it, I like what we do, but I’m embarrassed when it takes me forever to get to a call. [In Toronto], you have won the lottery in getting an ambulance with the right crew for the right problem within nine minutes.”

As the gulf between Toronto paramedics and the city that employs them has widened over the past month, front-line EMS staff have waged war against management in the media, highlighting questionable hiring and spending practices. Their list of grievances ranges from EMS managers claiming tens of thousands of dollars in overtime, to the purchase of top-of-the-line vehicles for supervisors, to an apparently faulty garage expansion that left EMS buses struggling to navigate the driveway’s turning radius. One former paramedic told the Post that the service’s emergency support units — which include multi-patient buses and emergency support trucks — were taken out of service several times over the past month to compensate for short-staffing on ambulances.

“There’s just no slack in the system whatsoever,” added Greg Trent, an advanced-care paramedic who has been with the service since the mid-1980s.

The recent suspensions of paramedics Ken Horton and Mike Merriman, who were taken to task for publicly criticizing EMS management, stoked their colleagues’ anger, prompting a petition calling on the city to investigate the sanctions. The Post has learned a third paramedic, just days shy of the end of his probationary period, was terminated last week for “unprofessionalism” after posting critical comments to his Facebook page.

“We are being bullied by our department and we’re kind of capitulating to it,” observed one paramedic, “because what’s the other option? Stay home without pay for a week? That’s not an option for me.”

Chief Raftis, who rejected many of the latest claims concerning management overtime and questionable spending, maintains the discord is driven by a small faction of paramedics “who are opposed to management’s introduction of a new shift schedule for paramedics,” which takes effect on Jan. 23.

For 35 years, any changes to paramedics’ schedule required the union’s agreement — until the city won concessions during the latest round of bargaining, which put more control in the hands of management.

Chief Raftis says the new schedule takes into account shifting call volumes, with more calls coming in on nights and weekends now that the service’s focus is almost exclusively on emergency calls, as opposed to non-emergency transports. The old schedule contributed to high levels of overtime among paramedics, he said, and the tweaks were meant to alleviate that pressure.

There are many staff who recognize the need for change and have found new options and flexibility as a result

“Toronto EMS and our employees, including paramedics, are extremely dedicated medical professionals,” spokeswoman Kim McKinnon noted. “Toronto EMS is changing some long-standing practices that have not kept pace with call volume and patient care. It is true that these changes have caused some dissatisfaction among paramedics, [but] there are many staff who recognize the need for change and have found new options and flexibility as a result.”

Others warn the changes will affect service, as more highly trained paramedics opt for lower-level positions in order to maintain a favourable schedule. Gary Beirness, a Level 3 paramedic with nearly two decades of service, is among an estimated 15 to 20 advanced-care paramedics planning to drop down to a Level 2 position, because he needs to co-ordinate hours with his paramedic wife. The couple has two young children and must balance their schedules for child-care reasons, but the decision to forgo his higher training was “extremely difficult,” Mr. Beirness said.

“We’re open to [changing the schedule],” Mr. Trent added, “but I don’t think we’re open to just having the whole service blown up and starting over.… It’s unprecedented; nothing like this has ever happened.”

The schedule bidding process will conclude next month, and while the service expects “a small number” of paramedics to downgrade, Ms. McKinnon said, “this will not impact our ability to… provide service to the community.”

In the meantime, a consultants’ report on EMS staffing numbers is expected within the next few weeks. For paramedics such as Mr. Beirness, change cannot come soon enough.

“The pace has become unbearable,” he said. “My ability to make life-saving decisions is hampered from lack of rest, going from call to call, often with no lunch… I feel this puts the public in danger, and the patients are not getting the proper treatment in a timely manner.”

Chief Raftis, who openly acknowledges the shortage, says the pending report will give EMS a better understanding of how many additional staff are needed — and once that data lands, the service will act accordingly.

“They are doing a full review, front to back, including the staffing requirements for today, but as well into the next 10 years. That’s the process that we have to follow in order to identify the need,” Chief Raftis said.